General

Clinical Question:
What is the prognosis of adults with a bicuspid aortic valve?

Bottom Line:
Primary cardiac events, including surgery for valve and aortic complications, occurred in 25% of adults with newly diagnosed bicuspid aortic valves who were followed up for a mean of 9 years. During this same period, all-cause mortality was similar to age-matched population estimates. Independent predictors of cardiac events were being older than 30 years, having moderate or severe aortic stenosis, and having moderate or severe aortic regurgitation. (LOE = 1b)

Reference:
Tzemos N, Therrien J, Yip J, et al. Outcomes in adults with bicuspid aortic valves. JAMA 2008;300(11):1317-1325.  [PMID:18799444]

Study Design:
Cohort (prospective)

Setting:
Outpatient (specialty)

Synopsis:
Bicuspid aortic valve is a common congenital cardiac anomaly found in adults, most often resulting from evaluation of cardiac murmurs. These investigators identified 642 adults (mean age = 35 years) who consecutively presented to a Canadian cardiac center as a result of referral for recently diagnosed bicuspid aortic valve. Patients referred for cardiac surgery or with complex congenital cardiac defects were excluded. Individuals reviewing health records verified all cardiac event outcomes and deaths. Complete follow-up occurred for all patients for a mean of 9 years (2 - 26 years). Overall survival rates of patients with bicuspid valves was similar to age-matched population estimates (97% at 5 years, 96% at 10 years). Primary cardiac events, including surgery for aortic valve or ascending aorta complications, hospital admission for congestive heart failure, aortic dissection/aneurysm, and cardiac deaths, occurred in 161 patients (25%). Independent predictors of cardiac events were being older than 30 years, having moderate or severe aortic stenosis, and having moderate or severe aortic regurgitation.